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Subclinical thyroid dysfunction and risk of atrial fibrillation: a meta-analysis

ObjectiveTo systematically review the relationship between subclinical thyroid dysfunction and the risk of atrial fibrillation.MethodsDatabases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data were electronically searched to collect cohort studies on associations between subclinical thyroid dysfunction and atrial fibrillation from inception to June 2020. Two reviewers independently screened literature, extracted data, and evaluated risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 11 studies involving 620 874 subjects and 19 781 cases were included. Meta-analysis showed that subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.20, 95%CI 0.92 to 1.57, P=0.18) and subclinical hyperthyroidism could increase the risk of atrial fibrillation (adjusted RR=1.65, 95%CI 1.12 to 2.43, P=0.01). Subgroup analysis showed that for the community population, subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.03, 95%CI 0.84 to 1.26, P=0.81); for cardiac surgery, subclinical hypothyroidism could increase the risk of atrial fibrillation (adjusted RR=2.80, 95%CI 1.51 to 5.19, P=0.001); subclinical hyperthyroidism could increase the risk of atrial fibrillation among patients with TSH≤0.1 mlU/L (adjusted RR=2.06, 95%CI 1.07 to 3.99, P=0.03) and TSH=0.1～0.44 mlU/L (adjusted RR=1.29, 95%CI 1.01 to 1.64, P=0.04). ConclusionsSubclinical hypothyroidism is not associated with atrial fibrillation and subclinical hyperthyroidism can increase the risk of atrial fibrillation. Due to limited quantity and quality of included studies, more high quality studies are needed to verify above conclusions.

甲状腺功能亢进症32例临床分析

目的:提高对甲亢患者的诊治水平,减少误诊率。方法:依据甲亢患者临床表现,回顾性分析误诊病例与甲亢产生多系统表现的可能机制。结果:32 例中有22 例在首诊时误诊,误诊率68.7%,其中,男性,尤其是老年男性患者,主要以消瘦,营养不良性贫血,失眠,心房纤颤,腹泻,呕吐,低钾周瘫,白血球减少误诊;女性主要以心悸,经量减少或闭经,慢性腹泻,类风湿性关节炎误诊。结论:甲亢患者可出现多系统临床表现,误诊与病程长短、性别及年龄,高代谢不明显,突眼少见,甲状腺肿大不明显有关。因此,对一些不典型的甲亢患者,及时行甲状腺功能检查。

CLINICAL OBSERVATION OF THE MANAGEMENT OF HYPERTHYROIDISM IN PERI SURGICAL PERIOD AND THE CHANGE OF T3 AND T4 CONCENTRATION

目的 探讨甲状腺功能亢进症(甲亢)围手术期T3、T4水平的变化及其临床意义。方法 检测30例甲亢患者服碘及心得安作术前准备前(a)、术日晨(b)、术中(c)、术后第1天(d)及术后第5天(e)各时相点T3、T4水平。结果 全组患者均未发生甲状腺危象，T3、T4水平a＞b＞c＞d＞e，其中a、b、c高于正常值，d、e值在正常范围。结论 经术前准备，甲亢患者符合临床手术条件时，血T3、T4仍然高于正常水平； 手术未造成甲状腺激素大量释放； 术后12及36小时时段甲状腺危象高发期T3、T4水平不高。

The Clinical Analysis of 124 Patients with Hyperthyroid Heart Disease

目的:探讨甲亢性心脏病的临床特点及131碘治疗的疗效分析。方法:对124例甲心病患者的临床资料及131碘治疗后疗效进行回顾性分析。结果:甲亢患者中甲心病发生率为86%,各年龄段均可发病,但40～60岁年龄段较高;甲亢病程越长甲心病发生率越高;甲心病131碘治疗的治愈率为879%;甲心病心律失常类型较多,以房颤最为多见; 131碘治疗后,各种心律失常复律百分率均大于80%。结论:甲亢患者并发甲心病的发病率与甲亢病程成正相关。早期正确诊断甲心病,可明显提高甲心病的疗效。131碘治疗是目前甲心病的最佳治疗方法。

Successful treatment of gastric perforation combined with hyperthyroidism crisis by MDT mode: a case report

ObjectiveTo investigate the diagnosis and treatment value of multi-disciplinary team (MDT) model in patient with gastric perforation combined with hyperthyroidism crisis.MethodWe summarized the experiences of MDT model in treating one case of gastric perforation with hyperthyroidism crisis in the Fuling Central Hospital of Chongqing City on February 2019.ResultsThis patient had a history of hyperthyroidism and didn’t receive systemic treatment, diagnosing as acute diffuse peritonitis and perforation of hollow organs. After MDT discussions and a series of treatments, including anti-infection, control of heart rate and hyperthyroidism, this patient underwent surgical treatment of gastric peptic ulcer perforation, during and after the surgery, this patient suffered from hyperthyroid crisis. The surgery was successful, with the operation time was about 110 min, and the blood loss was about 50 mL. There was no side injury occurred without blood transfusion, and the patient was cured and discharged on 20 days after operation. The patient was followed up for about 1 year, and the general condition and life returned to normal.ConclusionMDT discussion is a very helpful way in the treatment of gastric perforation combined with hyperthyroidism crisis and can give a better outcome.

Clinical Treatment of Children with Hyperthyroidism

目的 探讨儿童甲状腺功能亢进症的治疗措施及临床效果。 方法 对入选的200例儿童甲状腺功能亢进症患儿给予甲巯咪唑0.5~1.0 mg/(kg•d)、盐酸普萘洛尔0.3 mg/(kg•d)治疗，2~4个月待患儿甲状腺功能基本恢复正常后，将患儿随机分为对照组(n=100)及研究组(n=100)。对照组只给予甲巯咪唑治疗，研究组则继续给予甲巯咪唑并联合左甲状腺素钠治疗。比较治疗前和治疗后6个月、1年及2年患儿甲状腺体积，FT4、FT3和TSH水平，观察治疗后2年不良反应发生情况。 结果 与对照组比较，治疗6个月后研究组甲状腺体积明显降低(Plt;0.05)，药物性甲状腺功能减退症发生率低(Plt;0.05)，不良反应少。 结论 两种治疗措施均能有效改善儿童甲状腺功能亢进症的高代谢症候群，使FT3、FT4及TSH水平恢复正常，甲状腺体积明显降低，但甲巯咪唑联合左甲状腺素钠治疗能更安全有效地控制甲状腺肿大及药物继发性甲状腺功能减退症，并能减少症状复发。

Reoperation of Hyperthyroidism (Report of 32 Cases)

Nursing Experience for the Patients with Hyperthyroidism Treated by Radioactive 131I

【摘要】　目的　总结甲状腺功能亢症（甲亢）患者131I治疗中的护理特点及经验。　方法　2008年1-8月对收治的184例行131I治疗的甲亢患者，依据131I治疗特点采取针对性的护理措施：心理上帮助其消除紧张焦虑的情绪，饮食方面指导禁食碘物，并密切观察病情及预防甲亢危象，对服药中出现的一些不适症状及时对症处理。　结果　184例经131I治疗的甲亢患者3～6个月病情痊愈和缓解153例（83.15%），甲亢复发22例（11.96%），甲状腺功能减退症发生9例（4.89%）。　结论　有效对症的护理措施是甲亢患者积极配合治疗，早日获得康复的重要因素。【Abstract】　Objective　To summarize the nursing characteristics and experience for the patients with hyperthyroidism treated by 131I.　Methods　A total of 184 patients with hyperthyroidism underwent 131I treatment between January and August 2008 were included. We took care of the patients according to the therapeutic features of 131I treatment: helped them calm down, advised not eating iodine-containing food, observed the disease condition and dealt with the discomfort after medicated.　Results　In 184 patients with hyperthyroidism treated by 131I treatment for three to six months, 153 (83.15 %) were cured, 22 (11.96 %) recurred, and 9 (4.89 %) had hypothyroidism.　Conclusion　Comprehensive nursing is a key point to make the patients with hyperthyroidism cooperate and recover.

以精神症状为首发的病毒性脑炎合并甲状腺功能亢进患者的护理体会

目的探讨以精神症状为首发的病毒性脑炎合并甲状腺功能亢进（甲亢）患者的护理要点。 方法通过对2012 年8 月收治的1 例合并精神症状的病毒性脑炎合并甲亢患者的治疗、护理等临床资料的分析，总结病毒性脑炎与甲亢共存状况下如何进行针对性的护理。 结果患者病情得到及时控制，症状改善明显，治疗痊愈后出院。 结论以精神症状为首发的病毒性脑炎合并甲亢患者护理难度较大，需要医护人员提高对基础疾病及其症状的认识，给予及时、准确的判断和临床专科护理，减少并发症的产生，缩短住院时间，提高患者生活质量。

地塞米松联合用药方案在原发性甲状腺功能亢进患者术前准备中的临床实践经验

目的探讨地塞米松联合用药方案在原发性甲状腺功能亢进症（简称 “甲亢” ）患者术前准备中应用的效果。方法回顾性收集郑州大学第一附属医院甲状腺外科2021年1月1日至2022年10月1日期间收治的原发性甲亢手术患者。采用地塞米松联合碘剂和β-受体阻滞剂联合应用的7 d术前准备方案（简称 “7 d方案” ）：连续口服7 d复方碘溶液（3次/d，0.75 mL/次），在口服复方碘溶液的第5、6、7天时同时加用地塞米松注射液缓慢静脉滴注（1次/d，20 mg/次，上午10∶00开始，每次输入间隔时间24 h），手术前1 d口服β-受体阻滞剂普萘洛尔（剂量因人而异），于术前准备完成后第2天（第8天时）手术。观察入院时及使用地塞米松后的第1、2、3、4、5天时血清促甲状腺激素、游离三碘甲状腺原氨酸（free triiodothyronine，FT3）及游离甲状腺素（free thyroxine，FT4）水平的变化情况以及并发症情况。结果本研究共收集到58例患者，使用地塞米松后第1、2、3、4、5天时的FT3及FT4水平总体一直呈持续下降趋势（F=88.355，P<0.001；F=21.291，P<0.001），并且使用地塞米松后第2天开始FT3均值一直维持在正常水平，FT4均值虽未完全达到正常水平但比较接近正常水平；促甲状腺激素水平总体比较差异无统计学意义（χ2=1.607，P=0.900）。术后未发生甲状腺危象。结论从本研究结果看，“7 d方案”进行术前准备，较传统术前准备方法缩短了术前准备时间，对原发性甲亢的围术期管理安全、有效。